Femoral neck fractures in osteogenesis imperfecta treated with bisphosphonates.

PURPOSE: Osteogenesis imperfecta (OI) is a condition characterised by bone fragility and multiple fractures, which cause considerable morbidity in the affected patients. Most cases are associated with mutations in one of the type I collagen genes. Recently, bisphosponates have been used widely to reduce pain and the incidence of fragility fractures in OI in children, even though there have been concerns raised regarding the long-term complications of it due to their effect on the bone. The fragility fractures involving the neck of the femur in children with intramedullary rods in the femoral shaft are very difficult to treat. Although these fractures are frequently un-displaced, they require optimal internal fixation to achieve fracture union. The aim of this study was to assess the clinical and radiological outcomes of OI patients with intracapsular femoral neck fracture treated with headless compression screws. METHOD AND RESULTS: At our institute, we identified seven patients (11 hips) with OI who underwent internal fixation with headless compression screws for a neck of femur fracture between June 2010 and Dec 2012. The time to fractures healing was on average 14 weeks (12 to 16). All patients gained their pre-injury ambulatory status. CONCLUSION: It is very challenging and technically demanding for orthopaedic surgeons when treating the fragility fracture of the neck of femur in patients with intramedullary rod in the femoral shaft. The published data regarding the management of these complex conditions are very limited. We describe our experience with the technique of percutaneous headless compression screw fixation for treating the femoral neck fractures in OI patients.

Financial implications of plans to combat methicillin-resistant Staphylococcus aureus (MRSA) in an orthopaedic department.

INTRODUCTION: The aim of this study was to calculate retrospectively the cost of MRSA infections in the elective and trauma orthopaedic population in Rotherham District General Hospital in a 3-month period during 2005. PATIENTS AND METHODS: A total of 686 patients were admitted to the orthopaedic wards and the surgical wounds 10 patients became infected with MRSA. RESULTS: The cost of these infections when extrapolated over 12 months was pound384,000 excluding staff costs. CONCLUSIONS: The key in the fight against MRSA in the hospital setting is multifactorial and requires a combination of measures. Our solution is: cohort nursing; non-selective screening of all admissions to the orthopaedic wards; use of a polymerase chain reaction as a diagnostic tool; ring-fencing of beds; and separate wound dressing rooms for each ward. The total cost is projected to be pound301,000.

Acute transient bilateral trigger fingers.

A 30-year-old man presented with bilateral, simultaneous, transient triggering of the middle digits which developed acutely after prolonged and sustained use of a garden rotavator. He was asymptomatic in the period before presentation and has remained so 7 years since.